Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016

Abstract

Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the United States, causing substantial morbidity and mortality and costing billions of dollars annually. To update the estimated HCV prevalence among all adults aged ≥18 years in the United States, we analyzed 2013‐2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of HCV in the noninstitutionalized civilian population and used a combination of literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for four additional populations: incarcerated people, unsheltered homeless people, active‐duty military personnel, and nursing home residents. We estimated that during 2013‐2016 1.7% (95% confidence interval [CI], 1.4‐2.0%) of all adults in the United States, approximately 4.1 (3.4‐4.9) million persons, were HCV antibody‐positive (indicating past or current infection) and that 1.0% (95% CI, 0.8‐1.1%) of all adults, approximately 2.4 (2.0‐2.8) million persons, were HCV RNA–positive (indicating current infection). This includes 3.7 million noninstitutionalized civilian adults in the United States with HCV antibodies and 2.1 million with HCV RNA and an estimated 0.38 million HCV antibody‐positive persons and 0.25 million HCV RNA–positive persons not part of the 2013‐2016 NHANES sampling frame. Conclusion: Over 2 million people in the United States had current HCV infection during 2013‐2016; compared to past estimates based on similar methodology, HCV antibody prevalence may have increased, while RNA prevalence may have decreased, likely reflecting the combination of the opioid crisis, curative treatment for HCV infection, and mortality among the HCV‐infected population; efforts on multiple fronts are needed to combat the evolving HCV epidemic, including increasing capacity for and access to HCV testing, linkage to care, and cure.

Defining the hepatitis C cure cascade in an Urban health system using the electronic health record

“…An estimated 2.4 million adults were living with chronic hepatitis C virus (HCV) infection in the United States in 2013‐2016 . HCV prevalence is highest among persons born between 1945 and 1965 (2.6%), persons who inject drugs, males, non‐Hispanic Black persons, and persons with less education and family income . Only 55.6% of people with chronic HCV infection are aware of their infection .…”

Chronic Viral Hepatitis: Current Management and Future Directions

“…A meta‐analysis reported global HCV prevalence of 2.5%, ranging from 1.3% in the Americas to 2.9% in Africa . In the United States, an epidemiological study of the National Health and Nutrition Examination Survey (NHANES) revealed serologic antibody positivity in 1.7% (4.1 million) adults, with viremia seen in 1.0% (2.4 million) in 2013 to 2016 . In 2017, the Centers for Disease Control estimated 44,700 new cases of acute HCV infection, with an estimated 2.8 million people with chronic HCV in the United States…”

“…(4) In the United States, an epidemiological study of the National Health and Nutrition Examination Survey (NHANES) revealed serologic antibody positivity in 1.7% (4.1 million) adults, with viremia seen in 1.0% (2.4 million) in 2013 to 2016. (5) In 2017, the Centers for Disease Control estimated 44,700 new cases of acute HCV infection, with an estimated 2.8 million people with chronic HCV in the United States. (6) In the United States, although the disease burden from HCV is decreasing, the clinical characteristics of those with chronic infection is evolving.…”

Letter to the Editor: Hepatitis C Virus Prevalence Estimates Among Incarcerated Persons

“…Hofmeister identified populations with heightened hepatitis C virus (HCV) prevalence, including 2.1 million individuals incarcerated as of December 31, 2016, (1) estimating this population's HCV prevalence at 9.5× that of householders surveyed by the National Health and Nutrition Epidemiology Survey (NHANES). Yearly, the United States incarcerates 10 million people; subtracting 2.1 million incarcerated persons leaves 7.9 million in the NHANES frame who were recently released from prison/jail prior to the 1-day count (3% of all U.S. adults).…”

“…Spaulding and her colleagues raise a number of reasons why our study may underestimate the true prevalence of hepatitis C among incarcerated persons, but unfortunately, no nationwide data exist to assess the magnitude of these potential biases. According to 2016 Bureau of Justice Statistics data, most people arrested are detained in jails for short periods of time (1) ; thus, most of the number of persons cited in Dr. Spaulding's reply would be eligible for NHANES sampling. We could not further adjust estimates for potential nonresponse bias beyond those addressed through standard NHANES sample weights without risk of double-counting prevalent cases.…”